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Chapter 7
Physical Disabilities and Health
Problems
Physical Disabilities and Health
Impairments
• Physical impairments that relate to
problems involving skeleton, joints, and
muscles
• Health conditions related to limited
strength, vitality, or alertness due to
chronic or acute health problems
Cerebral
Palsy
Cerebral Palsy
Cerebral refers to the brain.
Palsy refers to weakness, paralysis or lack of
muscle control.
Physical Disabilities
• Cerebral palsy—neurological disorders
resulting in lack of control of muscle
movements:
– Spasticity—the muscles are spastic. They do
not contract and flex as they should.
– Hypotonicity—the muscles are floppy.
– Athetosis—fluctuating or uneven muscle tone.
– Ataxia—lack of motor coordination.
– Mixed—combination of two or more.
Physical Disabilities (continued)
• Classifications based on body parts
– Diplegia—all four extremities
– Hemiplegia—one side of the body
– Paraplegia—legs only
– Quadripelgia—arms, legs, trunk, and head
control
Causes of Cerebral Palsy
Some of the causes of
cerebral palsy include:
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blood type incompatibility between
mother and infant
premature birth
bacterial infection of the mother,
fetus or infant affecting the central
nervous system
loss of oxygen to the infant during
birth
physical injuries during or
following birth
lack of growth factors during intrauterine development
inability of placenta to provide the
fetus with oxygen and necessary
nutrients
What are the characteristics of
cerebral palsy?
Cerebral palsy can be grouped into three
main types which describe the disorders or
movement and posture that may be
experienced by a person.
These are called spasticity, athetosis and
ataxia.
Cerebral Palsy
• Spasticity occurs when muscles are high in
tone (tension) but weak in strength. A person
experiencing spasticity may have difficulty moving their
limbs and adopting stable posture.
• Athetosis refers to uncontrolled movements, which are
often most noticeable when a person with this type of
cerebral palsy commences movement. In addition,
children with athetoid cerebral palsy often have very
weak muscles or feel floppy when they are carried.
• Ataxia is characterized by unsteady, shaky movements
or tremor. People with ataxic cerebral palsy and related
disabilities have difficulty using muscles to achieve
balance and coordinated movement. This is the least
common type of cerebral palsy and related disabilities.
What part of the body is affected by
cerebral palsy?
Specific words are used to describe the parts of the individual's body that are affected.
Diplegia
Both legs and both arms are
affected, but the legs are
significantly more affected than
the arms. Children with diplegia
usually have some clumsiness
with their hand movements.
Hemiplegia
The leg and arm on one side of
the body are affected.
Quadriplegia
Both arms and legs are affected.
The muscles of the trunk, face and
mouth can also be affected.
Physical Disabilities (continued)
• Spinal cord injuries
– Spina bifida—imperfect development of the
spinal cord in utero
• Hydrocephalus—build up of fluid on the brain
• Incontinence—lack of control over bladder and
bowel movements
Spina Bifida
Spina Bifida means cleft spine, which is an incomplete closure in the spinal column
In general, the three types of spina bifida (from mild to severe) are:
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Spina Bifida Occulta: There is an opening in one or more of the vertebrae
(bones) of the spinal column without apparent damage to the spinal cord.
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Meningocele: The meninges, or protective covering around the spinal cord,
has pushed out through the opening in the vertebrae in a sac called the
"meningocele." However, the spinal cord remains intact. This form can be
repaired with little or no damage to the nerve pathways.
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Myelomeningocele: This is the most severe form of spina bifida, in which a
portion of the spinal cord itself protrudes through the back. In some cases, sacs
are covered with skin; in others, tissue and nerves are exposed. Generally,
people use the terms "spina bifida" and "myelomeningocele" interchangeably.
Effects of Spina Bifida
Depending on the severity and location of the defect,
people who have spina bifida can experience a wide
range of medical complications, including:
• Allergic reactions caused by prolonged exposure to latex
• Bladder, bowel and kidney problems
• Eye problems
• Fractures
• Hydrocephalus (excess fluid on the brain)
• Learning disorders
• Seizures
• Skin problems
• Tethered spinal cord
• Weight gain
Children with Spina Bifida
Physical Disabilities (continued)
• Muscular dystrophy—progressive
weakening of the muscles
– Duchenne’s disease—affects only boys;
weakness begins at hips and shoulders and
moves to arms and legs.
• Hip dysplasia—hip moves in and out of
socket.
– Usually found in girls and treated with braces
MUSCULAR DYSTROPHIES:
• Duchenne Muscular Dystrophy (DMD)
(Also known as Pseudohypertrophic)
• Becker Muscular Dystrophy (BMD)
• Emery-Dreifuss Muscular Dystrophy (EDMD)
• Limb-Girdle Muscular Dystrophy (LGMD)
• Facioscapulohumeral Muscular Dystrophy (FSH or FSHD)
(Also known as Landouzy-Dejerine)
• Myotonic Dystrophy (MMD)
(Also known as Steinert's Disease)
• Oculopharyngeal Muscular Dystrophy (OPMD)
• Distal Muscular Dystrophy (DD) (Miyoshi)
• Congenital Muscular Dystrophy (CMD)
Duchenne Muscular Dystrophy
(DMD)
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Definition - One of nine types of
muscular dystrophy, a group of
genetic, degenerative diseases
primarily affecting voluntary
muscles.
Cause - An absence of dystrophin,
a protein that helps keep muscle
cells intact.
Onset - Early childhood - about 2
to 6 years.
Symptoms - Generalized
weakness and muscle wasting first
affecting the musclesof the hips,
pelvic area, thighs and shoulders.
Progression - DMD eventually
affects all voluntary muscles, and
the heart and breathing muscles.
Survival is rare beyond the early
30s.
Physical Disabilities (continued)
• Juvenile rheumatoid arthritis—painful
inflammation around the joints
– Children should be encouraged to move.
– It often disappears by age 18.
Physical Disabilities (continued)
• Program implications
– Early intervention is key.
– Professionals work together for consistency in
therapy.
– Adaptive equipment may be necessary to
encourage movement and muscle strength.
Program Implications
• Team efforts
– Physical therapists
– Occupational therapists
– If there are language or hearing problems,
Speech Language Pathologists and
audiologists may be on the team
– Parents and teachers
– Psychologist if there are behavior problems
Physical Disabilities (continued)
• Adaptive equipment
– Mobility devices—braces, walkers,
wheelchairs
– Positioning devices—wedge mats, bolsters,
prone boards
Physical Disabilities (continued)
• Adapting materials
– Universal design approach
• Recognizing that a one-size-fits-all approach to
education does not work
• Understanding the need to design curricula to
meet the needs of all classroom learners
• Believing that all children who attend early
education programs will be successful in their
development and learning
Physical Disabilities (continued)
– Manipulative materials
• Wall displays
• Velcro on blocks
• Pegs on puzzle pieces
– Creative materials
• Use large pencils, paintbrushes
• Push pencils through a ball for an easier grip
• Tape paper to easel or table to prevent sliding
Physical Disabilities (continued)
– Self-help devices
• Use Velcro instead of buttons.
• Make utensils easier to grip for feeding.
• Use suction cups for soap.
Physical Disabilities (continued)
• Adaptations in the classroom
– Wheelchair accommodation
• Widen aisles
• Put materials up on shelves, not on the bottom
• Bathroom accessibility
– Railings
• Indoors and out, place railings to help children with
balance
Physical Disabilities (continued)
– Floor coverings
• Carpeting is best, if well stretched and securely
nailed down.
• If no carpeting, provide nonskid crutches and
shoes
– Eye-level materials
• Place objects at the children’s eye level for
independence.
Health Problems
• Some children are chronically ill and live
every day with serious health problems.
• Many developmental disabilities involve
significant health risks and problems.
Health Problems (continued)
• Asthma
– This is the most common and the most
serious.
– During an attack, a child cannot get a full
breath of air.
– Lips and nails may turn blue.
– If a child cannot get relief from medication,
emergency help needs to be called.
Asthma
• Asthma is one of the most common
chronic diseases of childhood.
• An estimated 4 million children under 18
years old have had an asthma attack in
the past 12 months, and many others have
"hidden" or undiagnosed asthma.
• Asthma is the most common cause of
school absenteeism due to chronic
disease
WHAT IS ASTHMA?
• Asthma is an inflammatory condition of the
bronchial airways.
– This inflammation causes the normal function of the
airways to become excessive and over-reactive, thus
producing increased mucus, mucosal swelling and
muscle contraction.
– These changes produce airway obstruction, chest
tightness, coughing and wheezing.
– If severe this can cause severe shortness of breath
and low blood oxygen.
• Each individual suffers a different level of
severity.
– Virtually, all children with asthma, however, do enjoy
a reversal of symptoms until something triggers the
next episode.
WHAT IS THE
CAUSE OF ASTHMA?
• Inflammation of the
airways is the
common finding in all
asthma patients.
• This inflammation is
produced by allergy,
viral respiratory
infections, and
airborne irritants
among others.
Health Problems (continued)
• Cystic fibrosis
– Children have excessive mucus, chronic
cough, progressive lung damage, and inability
to absorb fats and proteins.
– They also tend to have frequent, foul smelling
bowel movements and unusually salty
perspiration.
Cystic Fibrosis
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Cystic fibrosis (CF) is a chronic,
progressive condition that
primarily affects the body's
respiratory and digestive systems.
It is due to a gene defect that
causes the body to produce
abnormally thick mucous.
Approximately 30,000 children
and young adults in the U.S. have
CF. One in 31 Americans carries
an abnormal copy of the CF gene
but isn't sick with the disease. You
must have two abnormal copies of
the gene, one from your mother
and one from your father, to have
cystic fibrosis.
In the early 1950s, children born
with CF died early in childhood.
Today, thanks to improved
medical treatments, people with
CF often live into their 30s and
possibly beyond.
What Causes CF?
• CF occurs in children who have inherited two abnormal
copies of a specific gene, one from each parent.
• A parent who does not have CF but has one normal
copy of this gene and one abnormal copy is called a CF
carrier. The normal copy dominates, so the parent shows
no sign of CF. In some cases, carriers pass on their
normal copy of the CF gene to their child. In other
instances, they pass on their abnormal copy. A child who
receives a normal copy from one parent and an
abnormal copy from the other will be a CF carrier and
won't have the disease. A child who receives an
abnormal gene from both parents will develop CF.
• Males and females are equally likely to inherit CF.
Health Problems (continued)
• Hemophilia
– This is found only found in males.
– The blood does not clot normally, causing
serious internal bleeding.
Health Problems (continued)
• Leukemia
– This is the most common type of childhood
cancer.
– Chemotherapy is the most common
treatment.
Health Problems (continued)
• Sickle-cell anemia
– Autosomal recessive disorder
– Red blood cells are sickle in shape instead of
round, making it difficult for them to pass
through the bloodstream.
– Overall fatigue is one of the chronic problems.
– It is found only in African-American children.
Sickle Cell Anemia
• Sickle cell disease is an
inherited blood disorder
affecting red blood cells.
Normal red blood cells
contain hemoglobin A.
People with sickle cell
disease have red blood
cells containing mostly
hemoglobin S, an
abnormal type of
hemoglobin. These red
blood cells become
sickle-shaped (crescentshaped), and have
difficulty passing through
small blood vessels.
Sickle Cell Disease
• Sickle cell disease is not
spread like a cold and cannot
be caught from another
person.
• It is an inherited condition.
• Diagnosis of sickle cell
disease can only be
determined by a special blood
test.
Many people with sickle cell
disease live long and productive
lives.
• Comprehensive care includes
early diagnosis, preventive
measures, treatment of
complications, and ongoing
patient education.
•
Health Problems (continued)
• Heart problems
– Children with heart problems should be
encouraged to move.
– Monitor their skin color for a blue tone.
– Let the children tell you when they are too
tired to continue.
Health Problems (continued)
• Diabetes
– The body does not produce or properly use
insulin.
– Insulin is a hormone that is needed to convert
sugar, starches, and other food into energy
needed for daily life.
– There are two types of diabetes—type 1 and
type 2
Diabetes
• Type 1 diabetes is caused by an
autoimmune disorder-a problem with the
body's immune system.
• In a healthy body, specialized cells (called
beta cells) in the pancreas make insulin.
Insulin is a hormone that allows the body
to use energy from food.
• In type 1 diabetes, the immune system
mistakes beta cells for invaders and
attacks them. When enough beta cells are
destroyed, symptoms of diabetes appear.
Diabetes
• More common, and increasing
• In type 2 diabetes, the beta cells still
produce insulin.
• However, either the cells do not respond
properly to the insulin or the insulin
produced naturally is not enough to meet
the needs of the body.
Diabetes
• So insulin is usually still present in a
person with type 2 diabetes, but it does
not work as well as it should.
• Some people with type 2 can keep it under
control by losing weight, changing their
diet, and increasing their exercise. Others
take one or more medications, including
insulin.
Health Problems (continued)
– Hypoglycemia and hyperglycemia are the
result
• Hypoglycemia is excessively low levels of sugar in
the blood.
• Hyperglycemia is too much sugar in the blood.
• When in doubt, give a form of sugar.
– Regulate food intake.
– Monitor activity levels.
– Watch for changes in behavior.
Health Problems (continued)
• Seizure disorders
– Epilepsy is a form of seizure disorder.
– Types of seizures:
• Febrile seizures, brought on by a fast rising fever
• Generalized tonic-clonic seizures (grand-mal)
– Violent shaking and jerking
• Absence seizures (petit mal)
– Momentary loss of consciousness
– Often accused of daydreaming
Epilepsy and
Seizure Disorders
• Epilepsy is a brain disorder in which clusters of
nerve cells, or neurons, in the brain sometimes
signal abnormally. In epilepsy, the normal
pattern of neuronal activity becomes disturbed,
causing strange sensations, emotions, and
behavior or sometimes convulsions, muscle
spasms, and loss of consciousness.
• Epilepsy is a disorder with many possible
causes. Anything that disturbs the normal
pattern of neuron activity - from illness to brain
damage to abnormal brain development - can
lead to seizures.
Epilepsy
• Epilepsy may develop because of an
abnormality in brain wiring, an imbalance
of nerve signaling chemicals called
neurotransmitters, or some combination of
these factors.
• Having a seizure does not necessarily
mean that a person has epilepsy. Only
when a person has had two or more
seizures is he or she considered to have
epilepsy. EEGs and brain scans are
common diagnostic test for epilepsy.
Is there any treatment?
• Once epilepsy is diagnosed, it is important
to begin treatment as soon as possible.
• For about 80 percent of those diagnosed
with epilepsy, seizures can be controlled
with modern medicines and surgical
techniques
Types of Seizures
• Generalized seizures affect all or most of
the brain.
• They include petit mal and grand mal
seizures.
Petit Mal Seizures:
• Minimal or no movements (usually, except
for "eye blinking") -- may appear like a blank
stare
• Brief sudden loss of awareness or conscious
activity -- may only last seconds
• Recurs many times
• Occurs most often during childhood
• Decreased learning (child often thought to be
day-dreaming)
Grand Mal Seizures
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Whole body, violent muscle contractions
Rigid and stiff
Affects a major portion of the body
Loss of consciousness
Breathing stops temporarily, then "sighing"
Incontinence of urine
Tongue or cheek biting
Confusion following the seizure
Weakness following the seizure (Todd's
paralysis)
Seizure Disorders
• Partial psychomotor seizures
– Often appear like a tantrum
– Child unaware of behavior
– Become stereotypic for that child
– Medication is often prescribed.
Be aware of what to do during a
seizure:
• Remain calm.
• Cushion child’s head.
• Remove sharp objects.
• Do not put anything in the
child’s mouth.
Tourette Syndrome
• Tourette syndrome (TS) is a relatively
common neurologic disorder characterized by
sudden, brief movements or sounds called
tics.
• Pediatric neurologist Leon Dure, MD, says,
"The tics usually decrease in frequency when
patients concentrate on mental or physical
tasks and increase with boredom,
excitement, fatigue, heat, and stress."
Health Problems (continued)
• AIDS
– Caused by HIV
– Attacks the healthy immune system, leaving a
person vulnerable to illness
– Contracted through sexual contact, blood-toblood contact, and infected mother to baby
Health Problems (continued)
• Obesity
– Not necessarily a disability, it can lead to poor
self-esteem and other health risks.
– Child’s caloric intake exceeds caloric loss
through exercise.
– Increase child’s movement and limit the intake
of empty calories through junk food.
Health Problems (continued)
• Undernourishment
– Children consume too few calories, causing
low weight.
– It can result from poor chewing and
swallowing.
– Increase easy-to-swallow foods and consult
nutritionist for high-calorie, healthy food
choices.
Health Problems and Classroom
Practices
• Teachers should be informed of all health
issues related to the child that may impact
educational performance.
• Become educated on the illness,
prevention, and care.
Health Problems and Classroom
Practices (continued)
• Health records
– These should be kept on all children and
should include:
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Emergency telephone numbers
Names of doctors/dentists
Medications
Allergies
Immunizations
Health Problems and Classroom
Practices (continued)
• Administering medications
– This varies from state to state, but most
require the following:
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Parent permission
Child’s name on the bottle with the dosage
Medication log to be on file
Locked area to keep medication
Health Problems and Classroom
Practices (continued)
• Emergency considerations
– Emergencies need to be planned for, even
though we hope they never occur.
– Fire drills should be practiced monthly.
– Parents should be contacted about plans for
their child in case of emergency.
– Staff need a plan for classroom coverage.
– Staff should have CPR and first aid training.
Health Problems and Classroom
Practices (continued)
• Confidentiality
– Similar to a doctor, a teacher needs to
maintain confidentiality about students.
– Student files should not leave the building.
– Students should not be discussed outside of
work.
– Families need to know that they can trust the
teacher with this knowledge about their child.